球蛋白、白蛋白与球蛋白比值和纤维蛋白原在诊断人工关节周围感染方面表现良好。
Globulin, the albumin-to-globulin ratio, and fibrinogen perform well in the diagnosis of Periprosthetic joint infection.
机构信息
Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
出版信息
BMC Musculoskelet Disord. 2021 Jun 25;22(1):583. doi: 10.1186/s12891-021-04463-7.
BACKGROUND
Although periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty (TJA), the diagnosis of PJI remains challenging. Albumin (ALB), globulin (GLB), the albumin-to-globulin ratio (AGR), and fibrinogen could be indicators of the body's inflammatory state. This study aimed to compare the diagnostic accuracy of these biomarkers with that of other inflammatory biomarkers in PJI patients.
METHODS
We conducted a retrospective cohort study that included a consecutive series of patients undergoing debridement antibiotic irrigation and implant retention (DAIR), one-stage or the first stage of a two-stage revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) for acute (n = 31) or chronic (n = 51) PJI, or revision TKA or THA for aseptic failures (n = 139) between January 2017 and December 2019 in our hospital. The 2013 criteria of the Musculoskeletal Infection Society (2013 MSIS) were used as the reference standard for the diagnosis of PJI. The preoperative ALB, GLB, AGR, fibrinogen, D-dimer, platelet count, fibrin degradation product (FDP), platelet-to-lymphocyte (PLR), platelet count to mean platelet volume ratio (PVR), neutrophil-to-lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were assessed. The receiver operating characteristic curve (ROC), sensitivity, and specificity were utilized to compare different biomarkers.
RESULTS
Compared with the aseptic patients, the GLB, D-dimer, fibrinogen, FDP, platelet count, PVR, PLR, NLR, ESR, and CRP levels of PJI patients were significantly higher (P < 0.01); however, the ALB and AGR levels were significantly lower (P < 0.01). The area under the curve (AUC), sensitivity and specificity were 0.774, 67.50, 77.54% for ALB; 0.820, 57.50, 89.86% for GLB; 0.845, 66.25, 93.48% for AGR; 0.832, 78.48, 78.95% for fibrinogen; 0.877, 81.48, 85.07% for ESR; 0.909, 83.95, 88.89% for CRP; 0.683, 55.22, 75.83% for D-dimer; 0.664, 38.81, 88.33% for FDP; 0.678, 52.44, 79.86% for platelet count; 0.707, 48.78, 86.33% for PVR; 0.700, 51.22, 80.58% for PLR; and 0.678, 52.44, 81.30% for NLR, respectively. In the clinic, GLB, AGR and fibrinogen could be used for diagnosis of patients suspected of having PJI.
CONCLUSION
Our study demonstrated that GLB, AGR, and fibrinogen were promising biomarkers in the diagnosis of PJI.
背景
尽管假体周围关节感染（PJI）是全关节置换术（TJA）的严重并发症，但 PJI 的诊断仍然具有挑战性。白蛋白（ALB）、球蛋白（GLB）、白蛋白与球蛋白比值（AGR）和纤维蛋白原可以作为机体炎症状态的指标。本研究旨在比较这些生物标志物与其他炎症生物标志物在 PJI 患者中的诊断准确性。
方法
我们进行了一项回顾性队列研究，纳入了 2017 年 1 月至 2019 年 12 月期间在我院接受清创、抗生素冲洗和保留假体（DAIR）、一期或二期翻修全膝关节置换术（TKA）或全髋关节置换术（THA）治疗急性（n=31）或慢性（n=51）PJI，或因无菌性失败而进行翻修 TKA 或 THA（n=139）的连续患者系列。采用 2013 年肌肉骨骼感染协会（2013 MSIS）标准作为 PJI 诊断的参考标准。评估术前 ALB、GLB、AGR、纤维蛋白原、D-二聚体、血小板计数、纤维蛋白降解产物（FDP）、血小板与淋巴细胞（PLR）比值、血小板平均体积比值（PVR）、中性粒细胞与淋巴细胞比值（NLR）、红细胞沉降率（ESR）和 C 反应蛋白（CRP）水平。利用受试者工作特征曲线（ROC）、敏感性和特异性比较不同的生物标志物。
结果
与无菌患者相比，PJI 患者的 GLB、D-二聚体、纤维蛋白原、FDP、血小板计数、PVR、PLR、NLR、ESR 和 CRP 水平显著升高（P<0.01）；而 ALB 和 AGR 水平显著降低（P<0.01）。ALB 的曲线下面积（AUC）、敏感性和特异性分别为 0.774、67.50%、77.54%；GLB 为 0.820、57.50%、89.86%；AGR 为 0.845、66.25%、93.48%；纤维蛋白原为 0.832、78.48%、78.95%；ESR 为 0.877、81.48%、85.07%；CRP 为 0.909、83.95%、88.89%；D-二聚体为 0.683、55.22%、75.83%；FDP 为 0.664、38.81%、88.33%；血小板计数为 0.678、52.44%、79.86%；PVR 为 0.707、48.78%、86.33%；PLR 为 0.700、51.22%、80.58%；NLR 为 0.678、52.44%、81.30%。在临床上，GLB、AGR 和纤维蛋白原可用于诊断疑似 PJI 的患者。
结论
我们的研究表明，GLB、AGR 和纤维蛋白原是 PJI 诊断有前途的生物标志物。
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